Virtual surgery planning system and method

ABSTRACT

Systems and methods are disclosed herein. According to one example, the method can comprise imaging a target location of an anatomy of a patient to collect image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient, displaying based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient, and determining one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient. The method can convert the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cutting instrument.

CLAIM OF PRIORITY

This application claims the benefit of U.S. Provisional Patent Application Ser. No. 62/470,427, filed on Mar. 13, 2017, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.

FIELD

The present subject matter relates to surgical methods and systems, and more particularly, to surgical methods and systems that allow a cut guide to be customized for an individual patient.

BACKGROUND

In various orthopedic surgical procedures, bone grafts are often used to repair missing, damaged, or diseased bone. Bone grafts need to be sized, shaped, and oriented properly to replicate the patient's healthy bone. Bone grafts can be autologous or autografts (i.e., bone harvested from the patient's own body) or allograft (i.e., bone harvested from another patient or cadaveric bone obtained from a bone bank). By way of example, bone grafts to repair or replace a mandible can be harvested from a fibula.

Mandibular reconstruction can be necessary in some patients and can occur if the mandible is removed (e.g., for treatment of a cancerous growth). Many traditional mandibular reconstruction techniques rely on preserving and reintroducing parts of the original mandible back into the patient after treatment. Bone plates may be utilized to fuse portions of the original mandible back together, for example.

OVERVIEW

This disclosure pertains generally to systems and methods that help predict or overcome challenges that can arise during surgery. Typically, imaging technology such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, X-ray or other technology can be used to perform scans of an anatomy of interest of a patient. The images that are generated by this technology can be used for digital visual analysis and for the generation of 3D models for the affected bone area and surrounding tissue. With this, physicians are better able to determine how to treat the patient. For example, the data collected can be output to the physician so that he or she is better able to select patient-appropriate criteria for instruments that may be needed for treatment.

Determining an appropriate size and shape for bone grafts can present particular challenges especially as it relates to mandibular reconstruction. Mandibular reconstruction has traditionally been a lengthy and complicated process that takes into consideration the estimated number, length and orientation of fragments of the fibula used for the graft, the location of osteotomies that will be used, the gap between mandible stumps, curvatures of plates, along with other considerations. Bone for mandibular reconstruction should have an appropriate size and angulation for the particular patient when assembled. Current planning systems and methods lack the refinement to estimate size and angle of a section of a patient's mandible that will be removed and are not able to select bones (e.g., from the patient's fibula) having appropriate sizes and angle outputs for mandibular reconstruction to replace the bone removed. Devices for resecting the fibula to create grafts can lack precision in the selection of patient-appropriate size (e.g., bone length) and angle needed for each bone graft to yield a desirable outcome for the patient.

The present inventors have recognized, among other things, existing mandibular reconstruction can benefit from virtual surgery planning systems and methods. Such systems and methods can facilitate the virtual identification of bone that should be removed and can virtually identify a shape, angle, and/or length of bone grafts that can substitute for the removed bone. The systems and methods can additionally facilitate the selection of appropriate settings for a cut guide such that the cut guide has a patient-appropriate size and/or angle of cut to create the desired bone graft(s). Using the virtual surgery planning systems and methods, procedures such as mandibular reconstruction can be simplified so as to be performed more rapidly, with consideration for a lesser number of factors, and in a more reproducible surgical manner. Thus, the present inventor has invented systems and methods that include an adjustable fibula cut guide and adjusting settings on the fibula cut guide based on output from a visualization system to form a fibula cut guide that is specific to an individual patient's mandibles. According to some examples, the fibula cut guide can be configured to have various length settings, and the systems and methods disclosed can indicate to the physician which of the various size settings is appropriate to most closely match the needs of the patient undergoing the mandibular reconstruction.

To further illustrate the apparatuses and systems disclosed herein, the following non-limiting examples are provided:

Example 1 is a method that optionally can comprise: imaging a target location of an anatomy of a patient to collect image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; displaying based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determining one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; and converting the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cutting guide instrument.

In Example 2, the subject matter of Example 1 optionally includes constructing a virtual model of the target location, wherein the virtual model displays the one or more patient-specific characteristics of the anatomy of the patient.

In Example 3, the subject matter of any one or more of Examples 1-2 optionally include constructing a virtual model of the target location, wherein the virtual model displays a virtual bone graft that approximates the at least one bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.

In Example 4, the subject matter of any one or more of Examples 1-3 optionally include wherein the setting is one of a plurality of standard settings for the cutting instrument, and the setting is selected as a best match to the one or more patient-specific characteristics of the anatomy of the patient.

In Example 5, the subject matter of any one or more of Examples 1-4 optionally include wherein the setting is indicated by patient-specific markings on the cutting instrument.

In Example 6, the subject matter of Example 5 optionally includes The method Example 5, further comprising fabricating a cut guide for performing an osteotomy to recreate the bone of the target location from a second bone of the patient, wherein a design of the cut guide is based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient.

Example 7 is a system that can optionally comprise: a computer including at least one processor and a memory device, the memory device including instructions that, when executed by the at least one processor, cause the computer to: access image data of a target location of an anatomy of a patient, the image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; display based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determine one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; and convert the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cutting instrument.

In Example 8, the subject matter of Example 7 optionally includes instructions that cause the computer to construct a virtual model of the target location, wherein the virtual model displays the one or more patient-specific characteristics of the anatomy of the patient.

In Example 9, the subject matter of any one or more of Examples 7-8 optionally include instructions that cause the computer to construct a virtual model of the target location, wherein the virtual model displays a virtual bone graft that approximates the at least one bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.

In Example 10, the subject matter of any one or more of Examples 7-9 optionally include wherein the setting is one of a plurality of standard settings for the cutting instrument, and the setting is selected as a best match to the one or more patient-specific characteristics of the anatomy of the patient.

In Example 11, the subject matter of any one or more of Examples 7-10 optionally include wherein the setting is indicated by patient-specific markings on the cutting instrument.

In Example 12, the subject matter of Example 11 optionally includes a cut guide for performing an osteotomy to recreate the bone of the target location from a second bone of the patient, wherein instructions cause the computer to a design of the cut guide based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient.

In Example 13, the subject matter of any one or more of Examples 7-12 optionally include instructions that cause the computer to perform one or more of providing at least one anatomical measurement, at least one instruction, at least one recommendation, provide at least one of information, and at least one visual aid.

Example 14 is a machine-readable storage device including instructions that, when executed by a machine, can optionally cause the machine to: image data of a target location of an anatomy of a patient, the image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; display based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determine one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; and convert the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cutting instrument.

In Example 15, the subject matter of Example 14 optionally includes instructions to cause the machine to construct a virtual model of the target location, wherein the virtual model displays the one or more patient-specific characteristics of the anatomy of the patient.

In Example 16, the subject matter of any one or more of Examples 14-15 optionally include instructions to cause the machine to construct a virtual model of the target location, wherein the virtual model displays a virtual bone graft that approximates the at least one bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.

In Example 17, the subject matter of any one or more of Examples 14-16 optionally include wherein the setting is one of a plurality of standard settings for the cutting instrument, and the setting is selected as a best match to the one or more patient-specific characteristics of the anatomy of the patient.

In Example 18, the subject matter of any one or more of Examples 14-17 optionally include wherein the setting is indicated by patient-specific markings on the cutting instrument.

These and other examples and features of the present apparatuses, systems and methods will be set forth in part in the following Detailed Description. This Overview is intended to provide non-limiting examples of the present subject matter—it is not intended to provide an exclusive or exhaustive explanation. The Detailed Description below is included to provide further information about the present apparatuses, systems and methods.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numerals can describe similar components in different views. Like numerals having different letter suffixes can represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various examples discussed in the present document.

FIG. 1 shows a fibula cut guide having markings, in accordance with an example of the present disclosure.

FIG. 2 is a block diagram illustrating a system for virtual surgery planning, in accordance with an example of the present disclosure.

FIG. 3A is a flowchart illustrating a method of virtual surgery planning that can determine one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon one or more patient-specific characteristics of the anatomy of the patient, in accordance with an example of the present disclosure.

FIG. 3B is a flowchart illustrating a method of virtual surgery planning that can be used for mandibular reconstruction, in accordance with an example of the present disclosure.

FIG. 4 shows a virtual image of a reconstructed mandible, in accordance with an example of the present disclosure.

DETAILED DESCRIPTION

The present application relates to systems and methods of generating and outputting data comprising length settings for purposes of tailoring an adjustable fibula cut guide such that the cut guide can be used to create a bone graft most appropriate in size and shape for a patient.

The devices such as instruments disclosed herein can be aided by the use of computer-assisted image methods based on three-dimensional images of the patient's bones and/or adjacent anatomy generated by magnetic resonance imaging (“MRI”), computer tomography (“CT”), ultrasound, X-ray, or other medical imaging techniques. Various computer aided drafting (“CAD”) programs and/or other software can be utilized for the three-dimensional image reconstruction of the anatomy from the medical scans of the patient, such as, for example, software commercially available by Materialise USA, Plymouth, Mich. In some examples, the devices disclosed can be patient-specific from the outset. As such these patient-specific devices can be designed preoperatively using computer-assisted image methods based on three-dimensional images of the patient's joint and/or adjacent anatomy using the imaging technologies previously discussed.

Various pre-operative planning procedures and related patient-specific instruments are disclosed in commonly assigned and co-pending U.S. patent application Ser. No. 11/756,057, filed May 31, 2007; U.S. patent application Ser. No. 11/971,390, filed on Jan. 9, 2008; U.S. patent application Ser. No. 12/025,414, filed on Feb. 4, 2008; U.S. patent application Ser. No. 12/039,849 filed on Feb. 29, 2008; U.S. patent application Ser. No. 12/103,824, filed Apr. 16, 2008; U.S. patent application Ser. No. 12/371,096, filed Feb. 13, 2009; U.S. patent application Ser. No. 12/483,807, filed Jun. 12, 2009; U.S. patent application Ser. No. 12/872,663, filed Aug. 31, 2010; U.S. patent application Ser. No. 12/973,214, filed Dec. 20, 2010; and U.S. patent application Ser. No. 12/978,069, filed Dec. 23, 2010. The disclosures of the above applications are incorporated herein by reference.

The systems and methods disclosed can draw upon preoperative surgical plans. These plans can be formulated for a specific patient. A preoperative surgical plan can encompass virtual surgery planning with the aid of an electronic device such as a computer, as will be discussed subsequently. The systems and method can allow for interactive input from the patient's physician or other medical professional according to some examples. Imaging data from medical scans of the relevant anatomy of the patient can be obtained at a medical facility or doctor's office, using any of the medical imaging techniques discussed previously. The imaging data can include, for example, various medical scans of a relevant bone, bones or other relevant portion of the patient's anatomy, as needed for virtual anatomy modeling and, optionally, for virtual determination of bone graft size, shape (e.g. angle relative to other bone) and relative orientation. The imaging data, thus obtained, and other associated information can be used to construct a three-dimensional computer (digital) image of the anatomy of the patient. The three-dimensional digital image of the patient's anatomy and/or other gathered data can be used to formulate further steps of the preoperative surgical plan for the patient. The preoperative surgical plan can further include the identification and selection of particular bone grafts to be performed according to some examples. Such bone grafts can be selected to match the patient's anatomical need. For example, a disclosed fibula cut guide can be configured to have various length settings. Such settings can be standard settings that are not necessarily patient-specific, but can be adjusted based on data output to the physician comprising various size settings that most closely match the needs of the patient based upon the patient's anatomy. These size settings can be visually displayed to the physician as part of the surgical plan.

In some examples where a patient-specific device may be desired, the preoperative surgical plan can include the design and construction of such device. For example, the preoperative surgical plan can include the marking of the patient-specific guide with indicia in view of the patient's anatomy so that size-appropriate cuts and/or appropriately-angled cuts to the bone can be performed. In such case, the patient-specific guide can be manufactured by rapid prototyping methods, such as stereolithography or other similar methods or by CNC milling, or other automated or computer-controlled machining or robotic methods according to various examples. The guides can comprise disposable instruments that can be packaged and sterilized, and forwarded in a patient- and/or physician-specific system to the physician or the physician's medical facility for the corresponding orthopedic procedure according to one example.

The three-dimensional model of the patient's anatomy can be viewed on a computer display or other electronic screen and can also be reproduced as a hard copy on disk or other medium and viewed by direct or indirect or backlight illumination. The model can be sized for viewing on any appropriate screen size and may be cropped, rotated, etc., as selected by the individual (e.g., the physician) viewing the screen. The three-dimensional model can illustrate diseased bone that should be removed and can identify the shape and orientation of the bone grafts to be used in the replacement of the diseased bone. The three-dimensional model can further illustrate the patient-specific cut guide overlaid on a bone such as the patient's fibula (the bone used for the bone grafts) and can show the relevant cuts needed to make the bone grafts according to one example.

FIG. 1 shows an example of a fibula cut guide 10 according to an example of the present application. The fibula cut guide 10 can be constructed of a plurality of sections 12, 14, 16, 18, 20 and 22 that can be configured to couple together. Section 14 of fibula cut guide 10 shows various indicia (A, B, C, and D) that correspond to different length settings for section 14. While not shown, each of the other sections (12, 16, 18, 20, and 22) can also comprise indicia that correspond to different length settings for that particular section. By way of example, the indicia can comprise the section and length setting so as to enable the user to know which length setting to adjust the particular section to. For example, the indicia in section 14 may comprise 14A, 14B, 14C, and 14D, though the exemplary indicia in FIG. 1 and throughout this disclosure simply refers to A, B, C, and D. However, in other embodiments the indicia can comprise numbers (e.g., corresponding to a distance in mm or inches), symbols, markings or the like or a combination thereof. Further details regarding construction of the fibula cut guide can be found in the previously incorporated co-filed application Ser. No. 62/374,289 entitled “Fibula Cut Guide, Graft and Osteotomy System”.

As shown in the example of FIG. 1, the fibula cut guide 10 can be fabricated with various standard markings or indicia indicative of various lengths, such as A, B, C, D. As will be discussed in further detail below, the exemplary marking “A” of FIG. 1 can correspond to a virtual output “A” displayed to the user as described with reference to FIGS. 2-4. Put another way, the fibula cut guide 10 can be set to a most appropriate length (such as “A”) as indicated or suggested by the system output, as described with reference to FIGS. 2-4. Such settings calculation and display could comprise an angle setting according to other examples.

In the example of FIG. 2, a physician or other personnel can use a system, such as system 100, to locate diseased/non-diseased bone and/or other tissue in the applicable anatomy of a patient and to provide system output 111 to the physician or other personnel. The system 100 can also be utilized by the user to aid in selection and creation of appropriate grafts. For example, the system 100 can output settings for an instrument, such as fibula cut guide 10, appropriate to create bone grafts to treat the diseased bone. In FIG. 2, the system 100 can include a visualization system 110 receiving data from one or more of a bone database 150, a medical imaging system 160, or one or more additional databases 170. In some examples, the visualization system 110 can include a user-interface module 115, an image retrieval module 120, a selection module 125, an anatomical geometries module 130, and an image processing engine 140.

In an example, the user-interface module 115 can receive input from a user and provide feedback on the resulting measurements, other information on the anatomy selected, calculations, and resection locations, for example. According to some examples, the user-interface module 115 can provide guidance for instrument and/or bone graft configuration in view of the bone size, location, bone morphology, etc. This information can be used to aid in the creation of appropriately-configured bone grafts to replace diseased, missing, or injured bone. Such information can be used to select a most appropriate length of instrument from a plurality of length settings, for example. Such information can be used in selection of one or more appropriate settings for an instrument (e.g., a fibula cut guide) for the patient according to some examples. In one example, the user-interface module 115 can process inputs such as the selected bone morphology (e.g., bone size, bone shape, bone features, bone orientation) on a medical image of a region of interest. Additionally, the user-interface module 115 can process inputs and provide output (suggest instrument settings, perform calculations to identify and/or describe characteristics of the patient's anatomy). According to some examples, the user-interface module 115 can interface with user-interface components, such as a display and user-input mechanism (e.g., mouse, keyboard, or touch screen).

In an example, the image retrieval module 120 can retrieve a medical image for processing by the visualization system 110 from sources, such as the bone database 150 or the medical imaging system 160, among others. The image retrieval module 120 can communicate directly with the medical imaging system 160 to receive a radiographic (or similar) medical image of a patient's anatomy of interest for processing by the visualization system 110. Medical images processed by the visualization system 110 can be of any type of medical image that depicts internal structures of a patient's joint and soft tissue. Technologies such as X-Ray, Fluoroscopy, CT, True size imaging (EOS™), and MRI can all produce usable images. Other imaging technologies can be used with the methods and systems discussed herein.

The image processing engine 140 can run various image processing algorithms on the medical images retrieved by the image retrieval module 120. The image processing engine 140 can use image processing algorithms such as thresholding, edge detection, contrast detection, contrast-edge detection, and other known image processing techniques to perform the automated measurements.

According to the example of FIG. 2, the anatomical geometries module 130 can use data generated by the image processing engine 140 and/or the visualization system 110 to perform calculations to describe or characterize the geometry of one or more bones. These calculations can determine, for example, bone dimensions, orientation, bone axes/landmarks/positions, relative positions between bone portions, curvature and surface topography of the bone surface, and/or soft tissue attachment size and/or location, and the like.

In regard to the mandible of a patient, anatomical geometries module 130 can use data generated by the image processing engine 140 and/or the visualization system 110 to calculate the size, shape, relative position of the condyles (both left and right), the size, shape, relative position of the ramus (both left and right), the size, shape, relative position of the body (both left and right) including the position of the mid-bodies, and the location of the parasymphysis, for example.

According to some examples, the selection module 125 can use the calculations generated by the anatomical geometries module 130 and the visualization system 110 to determine and create an appropriately-sized virtual bone graft(s) and/or output appropriate settings for the cut guide such that the cut guide can be used to create bone grafts that approximate the virtual bone graft(s). For example, the selection module 125 can utilize the bone data as supplied by the visualization system 110, determine appropriate graft sections based upon the bone data. This can be used by the physician to adjust the dimensions of the cut guide to achieve the appropriate graft sections. Such calculation can be based on an algorithm for lengths parameters specific to geometry of a fibula cut guide 10 (FIG. 1) to produce the desired graft sections in view of that geometry, for example. According to some examples, the selection module 125 can retrieve data needed for the calculation from the database 170.

According to further examples, the selection module 125 can output (indicated by arrow 180) patient-specific length parameters, patient-specific angles and other patient-specific information as it relates to the fibula cut guide 10 (FIG. 1). Any of this data can comprise system output 111 as indicated in FIG. 2. Such output 180 can comprise displaying one or more appropriate length settings for the fibula cut guide 10 in order that the physician or other personnel can set the fibula cut guide 10 accordingly.

In further examples, the system output 111 can be to a fabrication system. General parameters (e.g., overall length, cut angle(s), segment lengths, thicknesses, width, etc., applicable to the fibula cut guide 10 (FIG. 1) can be stored in the database 170 for reference. Such information can be used by the fabrication system in the fabrication of the fibula cut guide 10 (FIG. 1) such that the fibula cut guide 10 would have patient-specific parameters such as overall length, segment lengths, cut angles. Such fabrication can be by rapid prototyping methods, such as stereolithography or other similar methods or by CNC milling, or other automated or computer-controlled machining or robotic methods according to various examples.

As part of the visualization system 110, the output parameters can be tested within the visualization system 110 allowing models of the proposed instrument (e.g., the fibula cut guide 10) with various parameters to be superimposed on bone and/or virtually implemented to create virtual bone grafts. These virtual bone grafts can be virtually constructed and/or superimposed on the existing anatomy (e.g., the patient's mandible) to aid in visualization and/or to determine if indeed an optimal graft geometry has been achieved.

According to one example, a method is disclosed that utilizes imaging data from a patient and performs calculations from the imaging data including determining locations of bone geometry and structure. From the calculations, surgical decisions including the adjustment of instruments such as cut guides to meet patient needs can be determined. The surgical decisions can be visualized electronically prior to being implemented. Based upon the visualization, the physician can alter his or her decision as desired.

FIG. 3A shows a flow chart of a method 200 according to one example of the present application. The method 200 can be used for virtual surgery planning of bone grafts. FIG. 3B provides a specific example of a method 300 of virtual surgery planning for mandibular reconstruction.

At a high level, the example of FIG. 3A can include: imaging a target location of an anatomy of a patient to collect image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; displaying based upon the collected image data, one or more patient-specific characteristics of the anatomy of the patient; determining one or more of a size, a shape and an orientation for at least one virtual bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; and outputting information about the patient-specific characteristics to allow for selection of appropriately-sized and/or shaped instruments to achieve a bone graft that matches the virtual bone graft.

As is further illustrated in the example of FIG. 3A, imaging 202 can be performed of the patient's anatomy of interest (a target location) using any one or combination of the technology previously discussed. Such scanning can collect 204 image data of the patient's anatomy of interest. Such image data can include at least one of a bone size, a bone orientation and a bone shape of the patient, for example. The collected image data can be stored such as in a database, file or other known medium including the Cloud. Image processing 206 of the image data can be performed as desired (e.g., to sharpen or contrast the image, to better identify anatomical surface features, etc.). The method 200 can perform 208 calculations to describe and/or characterized the geometry of bone in the anatomy of interest. The calculations can be performed upon the stored image data corresponding to the target location. These calculations can determine or describe, for example, patient-specific characteristics such as bone dimensions, bone axes/landmarks/positions, relative positions between bone portions, curvature and surface topography of the bone surface, and/or soft tissue attachment size and/or location, and the like. According to further examples, the calculations can be used to determine and/or describe the geometry and other characteristics of diseased bone that may require removal. According to some examples, the calculations can be used to determine and/or describe the geometry and other characteristics of bone that may not be removed during the procedure and can determine the patient-specific characteristics (e.g., bone dimensions, bone axes/landmarks/positions, relative positions between bone portions, curvature and surface topography of the bone surface, etc.) of that bone, in addition to or in alternative to the diseased bone.

The method 200 can determine 210 an appropriately-sized, shaped and/or oriented one or more virtual bone grafts as replacement for the diseased bone. Such determination can consider patient-specific characteristics regarding both the diseased bone and/or any adjacent bone that may be retained. The method can display 212 data to a physician or other personnel. For example, the display 212 can include a patient-appropriate setting(s) for the fibula cut guide 10 as previously illustrated as described in reference to FIG. 1 and further described below in step 214. According to another example, the display step 212 can include displaying data about the anatomy of interest and/or data regarding the area of interest to a physician or other personnel. Such displaying can further include display of patient-specific characteristics (e.g., diseased and/or healthy bone dimensions, bone orientation, surface topography, or the like). In some examples, displaying can include virtual assembly and/or arrangement of one or more virtual bone grafts relative the anatomy of interest, for example. The displaying can further include display of patient-specific characteristics (dimensions, orientation, etc.) of the one or more virtual bone grafts, which can be based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient.

According to one example, the display step 212 can comprise displaying a virtual three-dimensional model of the target location, where the virtual model can display the one or more patient-specific characteristics of the anatomy of the patient. According to yet another example, the virtual model can display the at least one virtual bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.

Method 200 can further convert 214 various of the patient-specific characteristics (e.g., size, shape, orientation, etc.) of the virtual bone grafts to corresponding setting parameters (e.g. relative length(s), shape, orientation of various cut slots, etc.) for the fibula cut guide 10 or other instrument used in the procedure (e.g., to create the one or more bone grafts). According to some examples, the corresponding setting parameters can be displayed so that the appropriate setting can be made to the fibula cut guide 10 or other instrument for aid of reference.

According to further examples, the method can fabricate the cut guide for performing an osteotomy to recreate the bone of the target location from a second bone of the patient (autograft) or of another patient (allograft). A design of the cut guide can be based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient.

According to the method 300 of FIG. 3B, imaging 302 can be performed on the patient's mandible using any one or combination of the technology previously discussed. Such scanning can collect 304 image data regarding the mandible. Such image data can include at least one of a bone size, a bone orientation and a bone shape of the mandible of the patient, for example. The collected image data can be stored such as in a database, file or other known medium including the Cloud. Image processing 306 of the image data can be performed as desired (e.g., to sharpen or contrast the image, to better identify anatomical surface features, etc.). The method 300 can perform 308 calculations to describe and/or characterize the geometry of bone in the anatomy of interest. The calculations can be performed upon the stored image data corresponding to the target location. The method 300 can perform 308 calculations to describe or characterize the geometry of the mandible. These calculations can determine, for example, patient-specific characteristics such as bone dimensions, bone axes/landmarks/positions, relative positions or lengths between bone portions, curvature and surface topography of the bone surface, and/or soft tissue attachment size and/or location, and the like. For example, the calculations can determine the relative locations of landmarks and the dimensions between those landmarks of the mandible. The landmarks can include location and dimensions between a first condyle to a first angle (i.e., a length of a first ramus, the first angle to first mid-body, the first condyle to first mid-body, the first angle to a parasymphysis (i.e., a length of a first body of the mandible) and the first condyle and the parasymphysis. Similar calculations can be performed for the opposing portion of the mandible across the parasymphysis.

According to further examples, the calculations can identify and characterize diseased portions of the mandible that may require removal from the image data. According to some examples, the calculations can identify bone that should not be removed during the procedure and can determine the patient-specific characteristics (e.g., bone dimensions, bone axes/landmarks/positions, relative positions between bone portions, curvature and surface topography of the bone surface, etc.) of that bone, in addition to or in alternative to the diseased bone.

The method 300 can determine 310 appropriately-sized, shaped and/or oriented one or more virtual bone grafts from the fibula as replacement for the diseased bone. Such determination can consider patient-specific characteristics regarding both the diseased bone and any adjacent bone that should be retained. The method can display 312 a virtual mandible, instrument settings for the fibula cut guide 10 or other appropriate information to the physician or other personnel. Such display can include visualization of patient-specific characteristics (e.g., diseased and/or healthy bone dimensions, bone orientation, surface topography, distance, orientation and position of the landmarks mentioned above, or the like). In some examples, the display step 312 can include display of virtual assembly and/or arrangement of the one or more virtual bone grafts relative to the anatomy of interest, for example. As part of the display step 312, the method 300 can translate 314 various characteristics (e.g., size, shape, orientation, etc.) of the one or more virtual bone grafts to corresponding setting parameters (e.g., relative length(s), shape, orientation of various cut slots, etc.) for the fibula cut guide 10 used in the procedure (e.g., to create the one or more bone grafts).

FIG. 4 shows a virtual image of a reconstructed mandible 400. According to the example of FIG. 4, a portion 402 of the reconstructed mandible 400 can be comprised of the original mandible bone of the patient (e.g., part or all of the ramus). A second portion 404 can comprise virtual bone grafts 406 that can be virtually constructed as illustrated. During the procedure bone can be cut from the fibula of the patient to form bone grafts that correspond to the virtual bone grafts. In the example of FIG. 4, the second portion 404 can comprise a part of the ramus as well as two bodies from a first angle 408 to a second mid-body 410. Thus, according to the example of FIG. 4, an entire part of a first body 412 and two osteotomy angles (only osteotomy angle 414 is shown in FIG. 4) are recreated with the virtual bone grafts 406. Further discussion of creation of bone grafts and assembly of a reconstructed mandible using a fibula cut guide can be found in co-filed application identified as Application Ser. No. 62/374,289, entitled “Fibula Cut Guide, Graft and Osteotomy System” filed on Aug. 12, 2016, the entire disclosure of which is incorporated herein by reference. In the example of FIG. 4, elongate bone plates used during the procedure are not displayed. The construction of such bone plate is described and illustrated in U.S. Pat. No. 6,423,068 and United States Patent Application Publication 2002/0062127A1, both of which are incorporated by reference in their entirety

In the example of FIG. 4, virtual calculation of a length of the first body 412 is undertaken from the first angle 408 to the first osteotomy angle 414 and the measurement (75 mm) can be displayed to the user. As shown in FIG. 4, an exemplary conversion output “A” can be displayed, signifying to the user to adjust a setting of the fibula cut guide to “A,” such as the “A” shown on the fibula cut guide 10 in FIG. 1. Other settings or indicia can be output to allow the user to adjust each length setting in each section of the fibula cut guide 10.

Additional Notes

Certain examples are described herein as including logic or a number of components, modules, or mechanisms. Modules may constitute either software modules (e.g., code embodied on a machine-readable medium or in a transmission signal) or modules. A module is tangible unit capable of performing certain operations and may be configured or arranged in a certain manner. In examples, one or more computer systems (e.g., a standalone, client or server computer system) or one or more modules of a computer system (e.g., a processor or a group of processors) may be configured by software (e.g., an application or application portion) as a module that operates to perform certain operations as described herein.

In various examples, a module may be implemented mechanically or electronically. For example, a module may comprise dedicated circuitry or logic that is permanently configured (e.g., as a special-purpose processor, such as a field programmable gate array (FPGA) or an application-specific integrated circuit (ASIC)) to perform certain operations. A module may also comprise programmable logic or circuitry (e.g., as encompassed within a general-purpose processor or other programmable processor) that is temporarily configured by software to perform certain operations. It will be appreciated that the decision to implement a module mechanically, in dedicated and permanently configured circuitry, or in temporarily configured circuitry (e.g., configured by software) may be driven by cost and time considerations.

Accordingly, the term “module” can be understood to encompass a tangible entity, such as hardware, that can be that an entity that is physically constructed, permanently configured (e.g., hardwired) or temporarily configured (e.g., programmed) to operate in a certain manner and/or to perform certain operations described herein. Considering examples in which modules are temporarily configured (e.g., programmed), each of the modules need not be configured or instantiated at any one instance in time. For example, where the modules comprise a general-purpose processor configured using software, the general-purpose processor may be configured as respective different modules at different times. Software may accordingly configure a processor, for example, to constitute a particular module at one instance of time and to constitute a different module at a different instance of time.

Modules can provide information to, and receive information from, other modules. Accordingly, the described modules may be regarded as being communicatively coupled. Where multiple of such modules exist contemporaneously, communications may be achieved through signal transmission (e.g., over appropriate circuits and buses) that connect the modules. In examples in which multiple modules are configured or instantiated at different times, communications between such modules may be achieved, for example, through the storage and retrieval of information in memory structures to which the multiple modules have access. For example, one module may perform an operation, and store the output of that operation in a memory device to which it is communicatively coupled. A further module may then, at a later time, access the memory device to retrieve and process the stored output. Modules may also initiate communications with input or output devices, and can operate on a resource (e.g., a collection of information).

The various operations of example methods described herein may be performed, at least partially, by one or more processors that are temporarily configured (e.g., by software) or permanently configured to perform the relevant operations. Whether temporarily or permanently configured, such processors may constitute processor-implemented modules that operate to perform one or more operations or functions. The modules referred to herein may, in some examples, comprise processor-implemented modules.

Similarly, the methods described herein may be at least partially processor-implemented. For example, at least some of the operations of a method may be performed by one or more processors or processor-implemented modules. The performance of certain of the operations may be distributed among the one or more processors, not only residing within a single machine, but deployed across a number of machines. In some example examples, the processor or processors may be located in a single location (e.g., within a home environment, an office environment or as a server farm), while in other examples the processors may be distributed across a number of locations.

The one or more processors may also operate to support performance of the relevant operations in a “cloud computing” environment or as a “software as a service” (SaaS). For example, at least some of the operations may be performed by a group of computers (as examples of machines including processors), these operations being accessible via a network (e.g., the Internet) and via one or more appropriate interfaces (e.g., Application Program Interfaces (APIs).)

Examples may be implemented in digital electronic circuitry, or in computer hardware, firmware, software, or in combinations of them. Examples may be implemented using a computer program product, e.g., a computer program tangibly embodied in an information carrier, e.g., in a machine-readable medium for execution by, or to control the operation of, data processing apparatus, e.g., a programmable processor, a computer, or multiple computers.

A computer program can be written in any form of programming language, including compiled or interpreted languages, and it can be deployed in any form, including as a stand-alone program or as a module, subroutine, or other unit suitable for use in a computing environment. A computer program can be deployed to be executed on one computer or on multiple computers at one site or distributed across multiple sites and interconnected by a communication network.

In examples, operations may be performed by one or more programmable processors executing a computer program to perform functions by operating on input data and generating output. Method operations can also be performed by, and apparatus of examples may be implemented as, special purpose logic circuitry, e.g., a field programmable gate array (FPGA) or an application-specific integrated circuit (ASIC).

The computing system can include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. In examples deploying a programmable computing system, it will be appreciated that both hardware and software architectures require consideration. Specifically, it will be appreciated that the choice of whether to implement certain functionality in permanently configured hardware (e.g., an ASIC), in temporarily configured hardware (e.g., a combination of software and a programmable processor), or a combination of permanently and temporarily configured hardware may be a design choice. Below are set out hardware (e.g., machine) and software architectures that may be deployed, in various examples.

The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other examples can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above detailed description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed example. Thus, the following claims are hereby incorporated into the detailed description as examples or embodiments, with each claim standing on its own as a separate example, and it is contemplated that such examples can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventor also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventor also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) can be used in combination with each other. Other examples can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above detailed description, various features can be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter can lie in less than all features of a particular disclosed example. Thus, the following claims are hereby incorporated into the detailed description as examples or embodiments, with each claim standing on its own as a separate example, and it is contemplated that such examples can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. 

The claimed invention is:
 1. A method comprising: imaging a target location of an anatomy of a patient including a bone to collect image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; displaying based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determining one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; converting the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cutting guide instrument, wherein the setting is one of a plurality of standard settings for the cutting guide instrument, wherein the setting is indicated by a plurality of markings or indicia corresponding to different lengths for the cutting guide instrument, and the setting is selected as a best match to the one or more patient-specific characteristics of the anatomy of the patient; and fabricating the cutting guide instrument with the setting for performing an osteotomy to form the at least one bone graft to recreate the bone of the target location from a second bone of the patient.
 2. The method of claim 1, comprising constructing a virtual model of the target location, wherein the virtual model displays the one or more patient-specific characteristics of the anatomy of the patient.
 3. The method of claim 1, comprising constructing a virtual model of the target location, wherein the virtual model displays a virtual bone graft that approximates the at least one bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.
 4. A method comprising: imaging a target location of an anatomy of a patient including a bone to collect image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; displaying based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determining one or more of a size, a shape and an orientation for at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; converting the one or more patient-specific characteristics of the anatomy of the patient to a setting for a cut guide; and fabricating the cut guide for performing an osteotomy to form the at least one bone graft to recreate the bone of the target location from a second bone of the patient, wherein a design of the cut guide is based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient, wherein the setting is indicated by patient-specific markings corresponding to different lengths on the cut guide.
 5. A system comprising: a cutting guide instrument configured to perform an osteotomy to form at least one bone graft to recreate a bone of a target location from a second bone of the patient; and a computer including at least one processor and a memory device, the memory device including instructions that, when executed by the at least one processor, cause the computer to: access image data of the target location of an anatomy of the patient, the image data regarding at least one of a bone size, a bone orientation and a bone shape of the patient; display based upon the collected image data one or more patient-specific characteristics of the anatomy of the patient; determine one or more of a size, a shape and an orientation for the at least one bone graft based at least in part upon the one or more patient-specific characteristics of the anatomy of the patient; convert the one or more patient-specific characteristics of the anatomy of the patient to a setting for the cutting guide instrument to perform the osteotomy to form the least one bone graft to recreate the bone of the target location from the second bone of the patient, wherein the setting is indicated by a plurality of markings or indicia corresponding to different lengths for the cutting guide instrument.
 6. The system of claim 5, further comprising instructions that cause the computer to construct a virtual model of the target location, wherein the virtual model displays the one or more patient-specific characteristics of the anatomy of the patient.
 7. The system of claim 5, further comprising instructions that cause the computer to construct a virtual model of the target location, wherein the virtual model displays a virtual bone graft that approximates the at least one bone graft along with the one or more patient-specific characteristics of the anatomy of the patient.
 8. The system of claim 5, wherein the setting is one of a plurality of standard settings for the cutting guide instrument, and the setting is selected as a best match to the one or more patient-specific characteristics of the anatomy of the patient.
 9. The system of claim 5, wherein the plurality of markings or indicia are patient-specific.
 10. The system of claim 5, further comprising instructions that cause the computer to perform one or more of providing at least one anatomical measurement, at least one instruction, at least one recommendation, provide at least one of information, and at least one visual aid. 